Comparing outcomes among patients with atrial fibrillation undergoing direct current cardioversion versus catheter ablation: A nationwide retrospective observational study
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
111
Name of Project's Faculty Sponsor
Venkata Vedantam
Faculty Sponsor's Department
Internal Medicine
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
INTRODUCTION The use of rhythm control strategies in patients with atrial fibrillation has increased in recent years. In our study, we compare the in-hospital outcomes between two common procedures used for rhythm control. METHODS Data was obtained from the Nationwide Inpatient Sample database between January 2016 to December 2020. The study included all adult patients who had a primary discharge diagnosis of atrial fibrillation during their hospitalization necessitating rhythm control with either direct current cardioversion(DCCV) or catheter ablation(CA). The primary outcome was inpatient mortality. Secondary outcomes were cardiac arrest, arrhythmias, acute respiratory failure, and acute renal failure, as well as the need for ventilators, dialysis, and ECMO. RESULTS Among 403,247 adult patients who had a primary discharge diagnosis of atrial fibrillation, 88,353 patients received either CA or DCCV. Among them, 17,927 (20.3%) received CA vs 70,426 (79.7%) who received DCCV. There was no significant difference between the two groups with respect to in-patient mortality (0.6% in both DCCV and CA, aOR: 0.96; 95% CI: 0.77-1.21, p=0.750); when adjusted for age, sex, race, and Charlson comorbidity index. However, those who underwent CA had a higher risk of acute respiratory failure (7.1% vs 5%, aOR: 1.47; 95% CI:1.37-1.57, p< 0.001) and ventricular arrhythmias (5.4% vs 4.2%, aOR:1.31; 95% CI: 1.21-1.41, p< 0.001). They required higher life-saving treatments like ECMO (11 vs 8, aOR:5.72; 95% CI: 2.30-14.26, p <0.001), blood transfusion (1.6% vs 0.7%, aOR: 2.35; 95% CI: 2.01-2.74, p< 0.001), and ventilator use (2.1% vs 0.9%, aOR:2.31, 95% CI: 2.03-2.63, p<0.001). There was no significant difference in the risk of cardiac arrest (0.6% vs 0.5%, aOR:1.20; 95% CI: 0.95-1.50, p= 0.123) CONCLUSION In this study comparing direct current cardioversion (DCCV) and catheter ablation (CA) in atrial fibrillation patients, DCCV showed better in-hospital outcomes despite no significant difference in mortality. CA patients had higher risks of respiratory failure, ventricular arrhythmias, and needed more interventions like ECMO, transfusions, and ventilation. While DCCV offers immediate advantages, its inability to address the underlying etiology of the ectopic impulses may cause increased chances of recurrence necessitating CA in the future, highlighting the need for long-term comparative studies to guide atrial fibrillation management effectively.
Comparing outcomes among patients with atrial fibrillation undergoing direct current cardioversion versus catheter ablation: A nationwide retrospective observational study
D.P. Culp Center Ballroom
INTRODUCTION The use of rhythm control strategies in patients with atrial fibrillation has increased in recent years. In our study, we compare the in-hospital outcomes between two common procedures used for rhythm control. METHODS Data was obtained from the Nationwide Inpatient Sample database between January 2016 to December 2020. The study included all adult patients who had a primary discharge diagnosis of atrial fibrillation during their hospitalization necessitating rhythm control with either direct current cardioversion(DCCV) or catheter ablation(CA). The primary outcome was inpatient mortality. Secondary outcomes were cardiac arrest, arrhythmias, acute respiratory failure, and acute renal failure, as well as the need for ventilators, dialysis, and ECMO. RESULTS Among 403,247 adult patients who had a primary discharge diagnosis of atrial fibrillation, 88,353 patients received either CA or DCCV. Among them, 17,927 (20.3%) received CA vs 70,426 (79.7%) who received DCCV. There was no significant difference between the two groups with respect to in-patient mortality (0.6% in both DCCV and CA, aOR: 0.96; 95% CI: 0.77-1.21, p=0.750); when adjusted for age, sex, race, and Charlson comorbidity index. However, those who underwent CA had a higher risk of acute respiratory failure (7.1% vs 5%, aOR: 1.47; 95% CI:1.37-1.57, p< 0.001) and ventricular arrhythmias (5.4% vs 4.2%, aOR:1.31; 95% CI: 1.21-1.41, p< 0.001). They required higher life-saving treatments like ECMO (11 vs 8, aOR:5.72; 95% CI: 2.30-14.26, p <0.001), blood transfusion (1.6% vs 0.7%, aOR: 2.35; 95% CI: 2.01-2.74, p< 0.001), and ventilator use (2.1% vs 0.9%, aOR:2.31, 95% CI: 2.03-2.63, p<0.001). There was no significant difference in the risk of cardiac arrest (0.6% vs 0.5%, aOR:1.20; 95% CI: 0.95-1.50, p= 0.123) CONCLUSION In this study comparing direct current cardioversion (DCCV) and catheter ablation (CA) in atrial fibrillation patients, DCCV showed better in-hospital outcomes despite no significant difference in mortality. CA patients had higher risks of respiratory failure, ventricular arrhythmias, and needed more interventions like ECMO, transfusions, and ventilation. While DCCV offers immediate advantages, its inability to address the underlying etiology of the ectopic impulses may cause increased chances of recurrence necessitating CA in the future, highlighting the need for long-term comparative studies to guide atrial fibrillation management effectively.